Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 1512  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  [PDF Not available] *
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case reports
 ::  Discussion
 ::  Acknowledgements
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed2262    
    Printed69    
    Emailed1    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal


 


 
ARTICLE
Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 189-191

Synovial chondromatosis


1 Department of Pathology, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012, India
2 Department of orthopaedic Surgery, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012, India

Correspondence Address:
Shaila A Nimbkar
Department of Pathology, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 529176

Rights and PermissionsRights and Permissions


 :: Abstract 

Two cases of synovial ehondromatosis are presented of which one falls in a rare group o f extra-articular ehondromatosis develop­ing in a bursa. Awareness of this rare lesion is important to prevent radical treatment owing to overdiagnosis. The histologic changes may mimic chondrosarcoma causing diagnostic problem.



How to cite this article:
Nimbkar SA, Sane SY, Patel B, Pathak R H, Bavdekar A V. Synovial chondromatosis. J Postgrad Med 1979;25:189-91

How to cite this URL:
Nimbkar SA, Sane SY, Patel B, Pathak R H, Bavdekar A V. Synovial chondromatosis. J Postgrad Med [serial online] 1979 [cited 2019 Dec 8];25:189-91. Available from: http://www.jpgmonline.com/text.asp?1979/25/3/189/42147



 :: Introduction Top


Synovial chondromatosis is a rare con­dition in which cartilage is formed in the synovial membranes of joints, tendon sheaths or bursae by metaplasia of the connective tissue under the surface of the synovial membrane. Secondary calcifica­tion or ossification may be seen in the cartilaginous nodules but it is not always present, hence the term synovial ehon­dromatosis is preferred to osteo-chondro­matosis.


 :: Case reports Top


Case 1

M.H., a twenty year old male was seen in May 108 at which time he complained of a lump in the right gluteal region of 4 months' duration. He gave history of dull aching pain which increased after walking for a long time. Physical examination showed an irregular, bony hard, swelling in the right gluteal region (see [Figure 1], on page 190A). There was no warm of tenderness and the right hip joint was normal.

There was no limitation of movements of the hip joint.

Roentgenograms showed multiple areas of speckled radio-opacity in the right gluteal re­gion appearing in connection to neck of the femur and greater trochanter (see [Figure 2], on page 190A). The hip joint was normal. Clini­cally, the case was diagnosed as chondrosarcoma arising from the neck of the femur.

On 26th May, wide excision of the tumor was done by postero-lateral incision of the right gluteal region. Multiple cartilaginous nodules and loose bodies were found in the bursa which was about 12 cms in diameter and was beneath the gluteus maximum muscle, reaching upto the greater trochanter. The right hip was free from the tumor. The bursa with its thickened carti­laginous wall and multiple loose bodies was excised.

Post-operatively, the patient developed haemorrhage and wound infection. Secondary suturing of the wound was done. Follow-up study has revealed that the patient's condition is good and all movements of the hip joint are normal.

Gross appearance

The bursa was about 12 cms x 10 cms, in size with a thickened wall showing multiple, polypoid, firm projections and small cartilaginous bodies, free in the cavity (see [Figure 3], on page 190A).

Histology

The bursa was lined by synovium which showed multiple islands of cartilage in the synovial connective tissue. Many of the chon­drocytes showed plump, irregular, hyperchro­matic nuclei, but there were no giant cells. Cal­cification and ossification was seen at places (see [Figure 4] and[Figure 5] on page 190B).

Case 2

S.N., a 16 year old male was first seen in April 1978, complaining of pain, swelling am restriction of movements of the right knee joint. There was no history of trauma or any history of similar complaints in other joints. There was history of fever off and on. Clinical diagnosis of tuberculosis of knee was made. Synovial biopsy was done which showed changes of mild chronic non-specific inflammation. Patient was put on antibiotics but there was no improvement. Roentgenograms of the right knee done repeat­edly showed normal knee joint. In May 1978, subtotal synovectomy was done by taking antero-medial incision over the right knee. The anterior synovium was thickened and showed polypoid hard masses while posteriorly it was normal. There were no loose bodies in the joint. Histology showed a picture of synovial chondromatosis with focal areas of calcification and ossification.

Post-operative course was uneventful.


 :: Discussion Top


While reviewing the literature on synovial chondromatosis, it is found that the condition lacks clear definition. Al­though many cases are reported to be synovial chondromatosis, true synovial chondromatosis is rare, when exacting diagnostic criteria including the finding of metaplastic foci of cartilage in the syno­vial membrane are employed. [6],[8],[9] Cer­tain authors suggested that at least some cases of multiple loose bodies not associ­ated with active intrasynovial disease are examples of this syndrome . [7],[10]

The etiology of synovial chondromato­sis remains an enigma. Many theories speculate about the role of trauma [10] or neoplasia. [6] Lexer postulated an overacti­vity of the embryonic rests at the junc­tion of the synovial membrane and arti­cular cartilage as the cause of chondro­matosis. [5]

The condition may affect any of the diarthrodial joints of the body. The knee is the site of involvement in about two thirds of patients with the hip or elbow about equally divided as the next most frequent site. A few cases are reported with extra-articular masses of carti­lage. [2],[4] The term "Bursal chondromato­sis" is applicable to those cases in which cartilaginous bodies develop in a bursal cavity originating from the lining of its wall. [13]

The males are affected twice as often as females and ages have ranged from 14 to 47 years with a peak in the 5th decade. The clinical findings are not distinctive and patients complain of various combin­ations of pain, swelling and limited motion. Radiological findings may be strongly suggestive of the disease in most of the cases but in about 10% of patients, no evidence may be present . [3]

The cytological atypia is many a times worrisome. [9] If the clinical and gross find­ings of chondromatosis show the disease confined to the synovium, the microscopic atypia can be discounted for all practical purposes. The presence of orderly ossific­ation further favours a benign course. [3] The malignant change occurring in syno­vial chondromatosis is rare. [1] There are a few reports with sarcomatous change in a nodule requiring radical surgery. [11],[12]

Even in the presence of roentgeno­graphic evidence or surgical demonstration of loose bodies, synovial chondroma­tosis should be distinguished from the more common causes which include osteoarthritis, osteochondritis dissecans, osteochondrol fractures, chronic infections etc., since the prognosis and treatment differ in case of synovial chondromatosis. The treatment consists, in principle, of clearing the joint of its free bodies and excising the affected synovium. Any re­maining synovium constitutes a possible source of new bodies, and the synovec­tomy should therefore be as nearly com­plete as possible.


 :: Acknowledgements Top


The authors thank Dr. S. G. Kinare, Professor of Pathology, and Dr. C. K. Deshpande, Dean, Seth G.S.M. College and K.E.M. Hospital for their kind per­mission to publish this paper.

 
 :: References Top

1.Ballard, R. and Weiland, L. H.: Syno­vial chondromatosis of the temporo-man­dibular joint. Cancer, 30: 791-795, 1972.   Back to cited text no. 1    
2.Dunn, A. W. and Whisler J. H.: Synovial chondromatosis of the knee with associat­ed extracapsular chondroma. J. Bone and Joint Surg., 55A: 1747-1748, 1973.  Back to cited text no. 2    
3.Fechner, R. E.: Neoplasms and neoplasm like lesions of the synovium: In "Bones and Joints"-International Academy of Pathology Monograph. The Williams and Wilkins Co. Baltimore, 1976, pp. 157-186.  Back to cited text no. 3    
4.Jeffreys, T. E.: Synovial chondromatosis, J. Bone and Joint Surg. 49B: 530-534, 1967.  Back to cited text no. 4    
5.Lexer, Erich: Galenhchondrome. Deutsche Zeitschr f. Chir. 88: 311-323, 1907-Cited by Mclvor, R. R. and King, D.: Osteo­chondromatosis of the hip joint. J. Bone and Joint Surg. 44A: 87-97, 1962.  Back to cited text no. 5    
6.Mclvor, R. R. and King, D.: Osteochon­dromatosis of the hip joint. J. Bone and Joint Surg., 44A: 87-97, 1962.  Back to cited text no. 6    
7.Milgram, J. W. and Addison, R. G.: Synovial osteochondromatosis of the knee. Chondromatous recurrence with possible chondrosarcomatous degeneration. J. Bone and Joint Surg., 58A: 264-266, 1976.  Back to cited text no. 7    
8.Murphy, A. F. and Wilson, J. N.: Teno­synovial osteochondroma in the hand. J. Bone and Joint Surg., 40A: 1236-1246. 1958.  Back to cited text no. 8    
9.Murphy, F. P., Dahlin, D. C. and Sullivan, C. R.: Articular synovial chondromatosis. J. Bone and Joint Surg., 44A: 77-86, 1962.  Back to cited text no. 9    
10.Mussey, R. D. Jr. and Henderson, M. S.: Osteochondromatosis, J. Bone and Joint Surg., 31A: 619-627, 1949.  Back to cited text no. 10    
11.Nixon, J. E., Frank, G. R. and Chamben, George: Synovial osteochondromatosis: with report of four cases one showing malignant change. U.S. Armed Forces Med., J., 11: 1434-1445, 1960.  Back to cited text no. 11    
12.Reimann, H. and Kienbock, R.: Uber "Gelents" Osteochondromatose mit sar­kombildung. Rontgenpraxis. 3: 942-944, 1931. Cited by Murphy, F. P., Dahlin. D. C. and Sullivan, C. R.: Articular synovial chondromatosis. J. Bone and Joint Surg., 44A: 77-86, 1962.  Back to cited text no. 12    
13.Symeonides, P.: Bursal chondromatosis, J. Bone and Joint Surg., 48B: 371-373, 1966.  Back to cited text no. 13    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow